An effective date prior to November 13, 2024, for the grant of a 100 percent rating for adjustment disorder with mixed disturbance of emotions and conduct with panic attacks, insomnia disorder, and alcohol use disorder…

Citation Nr: A26069969 Decision Date: 07/30/26 Archive Date: 07/30/26 DOCKET NO. 260410-664892 DATE: July 30, 2026 ORDER An effective date prior to November 13, 2024, for the grant of a 100 percent rating for adjustment disorder with mixed disturbance of emotions and conduct with panic attacks, insomnia disorder, and alcohol use disorder is denied. FINDINGS OF FACT 1. The Veteran served on active duty from August 2016 to April 2021; he has been 100 percent disabled since November 2024. 2. It was not factually ascertainable that the Veteran's symptoms approximated the criteria for a 100 percent rating for a mental health disability prior to November 13, 2024. CONCLUSION OF LAW The criteria for an effective date prior to November 13, 2024, for the grant of a 100 percent rating for adjustment disorder with mixed disturbance of emotions and conduct with panic attacks, insomnia disorder, and alcohol use disorder have not been met. 38 U.S.C. §§ 5103 (a), 5103A, 5107, 5110 (2012), 38 C.F.R. §§ 3.155, 3.400, 3.2500 (2026). REASONS AND BASES FOR FINDINGS AND CONCLUSION This decision has been written under the guidelines of the Veterans Appeals Improvement and Modernization Act, also known as the Appeals Modernization Act (AMA). In April 2024, the agency of original jurisdiction (AOJ) increased the rating for a mental health disability from 50 percent to 70 percent, effective November 16, 2023. In January 2025, the Veteran filed an increased rating claim for his psychiatric disorder on VA 21-526EZ (Fully Developed Claim). In April 2025, the AOJ increased the psychiatric evaluation to 100 percent effective November 13, 2024. In October 2025, the Veteran appealed to the Board via a VA Form 10182 disputing an earlier effective date for the grant of the 100 percent rating. In December 2025, he expressed an intent to withdraw that appeal. In February 2026, the Board issued a decision dismissing the claim for an earlier effective date. In April 2026, he again appealed to the Board via a VA Form 10182 and elected the Direct Review docket. Therefore, the Board may only consider the evidence of record at the time of the AOJ decision on appeal. Turning to the laws and regulations, the effective date for an increased rating shall be the earliest date of which it is factually ascertainable that an increase in disability had occurred, if the claim is received within one year from such date, otherwise, the effective date for increased ratings shall be the date of receipt of claim or date entitlement arose, whichever is later. 38 C.F.R. § 3.400(o)(1). An effective date for an increased rating may be assigned later than the date of receipt of the claim, if the evidence shows that the increase in disability actually occurred after the claim was filed, but never earlier than the date of receipt of the claim for increase. In general, "date of receipt" means the date on which a claim, information or evidence was received in VA. 38 C.F.R. § 3.1(r). The effective date for an award of service connection is the day following separation from active service or the date entitlement arose, if the claim is received within one year after separation from service, otherwise, the effective date is the later of the date of receipt of the claim or the date entitlement to service connection arose. 38 C.F.R. § 3.400(b)(2). The decisions of the AOJ or the Board are final. 38 U.S.C. § 7105, 38 C.F.R. §§ 20.302. 20.1103; however, VA will readjudicate a claim if new and relevant evidence is presented or secured. 38 C.F.R. § 3.156(d). "Relevant evidence" is evidence that tends to prove or disprove a matter at issue. 38 C.F.R. § 3.2501(a)(1). The regulations in effect since March 24, 2015, require that claims be submitted on an application form prescribed by the Secretary and do not allow for informal claims not submitted on such a form. See 38 C.F.R. §§ 3.155, 3.160. In addition, there is no provision in the law for awarding an earlier effective date for a grant of service connection based simply on the presence of the disability in treatment records. See Brannon v. West, 12 Vet. App. 32, 35 (1998). Effective March 24, 2015, VA created an intent to file (ITF) form, allowing for a claimant to file a general intent to submit a claim for compensation and to preserve this date of claim by filing a formal claim for benefits within a year. 38 C.F.R. § 3.155(b). A claimant or his or her duly authorized representative may indicate a claimant's desire to file a claim for benefits by submitting an ITF a claim to VA. An ITF must provide sufficient identifiable or biographical information to identify the claimant. Upon receipt of the ITF, VA will furnish the claimant with the appropriate application form prescribed by the Secretary. If VA receives a complete application form prescribed by the Secretary, as defined in paragraph (a) of § 3.160, appropriate to the benefit sought within 1 year of receipt of the ITF, VA will consider the complete claim filed as of the date the ITF was received. Under the AMA, a determination on a claim by the AOJ becomes final unless the claimant continuously pursues the claim by filing a Supplemental Claim, a request for a Higher-Level Review (HLR), or an appeal to the Board via a VA Form 10182 within one year of the date the AOJ mails notice of the decision. 38 C.F.R. §§ 20.1103, 3.2500(c)(1). If a claimant continuously pursues an issue by filing one of these administrative review options within one year, the effective date will be the date of receipt of the initial claim or the date entitlement arose, whichever is later. 38 C.F.R. § 3.2500(h)(1). If a Supplemental Claim is received more than one year after the date on which the AOJ issued notice of a decision, the effective date will be the date of receipt of the Supplemental Claim, or the date entitlement arose, whichever was later. 38 C.F.R. §§ 3.400, 3.2500(h)(2). In addition, an application that had been previously denied cannot preserve an effective date for a later grant of benefits based on a new application. 38 C.F.R. § 3.400(q). Thus, the effective date of an award of service connection is not based on the earliest medical evidence showing a causal connection, but on the date that the application upon which service connection was eventually awarded was filed with VA. Lalonde v. West, 12 Vet. App. 377, 382 (1999). The Veteran is seeking an effective date prior to November 13, 2024, for the grant of a 100 percent rating for a mental health disability. He asserts the proper date should be November 16, 2023, based on continuous pursuit of the psychiatric claim that originated when he filed an ITF on that date. Historically, the Veteran filed an ITF on November 16, 2023, followed by a VA 21-526EZ (Fully Developed Claim) in February 2024 seeking an increased rating for his adjustment disorder with mixed disturbance of emotions and conduct with panic attacks, insomnia disorder, and alcohol use disorder. In April 2024, the AOJ increased the psychiatric evaluation from 50 percent to 70 percent, effective November 16, 2023, date of the ITF. On November 13, 2024, the Veteran filed another ITF followed by a VA 21-526EZ (Fully Developed Claim) in January 2025 seeking another increased rating for the mental health disability. In April 2025, the psychiatric rating was increased to 100 percent effective November 13, 2024, date of the second ITF. In the AMA, if a veteran would like to continuously pursue a rating assigned in a prior decision, within a year of issuance of that decision, they should file a request for HLR (on a VA Form 21-0996), a Supplemental Claim (on a VA Form 21-0995), or a Board appeal (on a VA Form 10182). 38 C.F.R. § 3.2500 (a). If done, the veteran would be understood to be expressing disagreement with, or requesting review of, a prior rating decision. Specifically, continuous pursuit of a claim or an issue can be achieved by timely and properly filing an appropriate review option, generally within one year. 38 C.F.R. § 3.2500(c). If a claim is continuously pursued, it will be considered filed as of the date of the first claim in the continuously pursued chain, as opposed to the date the most recent request for review was received. 38 C.F.R. §§ 3.400, 3.2500(c). However, if a claimant files a new increased rating claim on VA Form 21-526EZ during the timeframe during which they could request HLR, file a Supplemental Claim, or appeal the decision to the Board, this does not establish continuous pursuit of a claim. 38 C.F.R. § 3.2500 (h). This is because the newly-filed VA Form 21-526EZ is a request for a higher rating based on a change or worsening in severity, as opposed to a request for a review of a prior decision. Here, there was no increased rating claim pending when the VA received the January 2025 VA 21-526EZ. As such, that application is considered a new request for a higher rating for a mental health disability. As such, the Board will determine the earliest possible effective date for the grant of a 100 percent rating for the psychiatric disorder. The Veteran asserts that an effective date of November 16, 2023, is proper as the evidentiary record demonstrated a continuous progression of the same psychiatric disability, with overlapping and inseparable symptomatology, culminating in total occupational and social impairment that had already manifested during the original claim stream. In other words, he contends that the January 2025 claim was in continuous pursuit of the original November 2023 claim and did not establish a new onset of symptomatology. Additionally, the Veteran argues that the record reflected persistent and progressively severe psychiatric symptomatology of continuous panic and depression affecting independent functioning, significant memory impairment, impaired impulse control, chronic sleep impairment, disturbances of motivation and mood, neglect of personal hygiene, and an inability to establish and maintain effective relationships, all resulting in profound occupational and social impairment. However, the medical records do not reflect that the Veteran's psychiatric symptoms worsened in the year prior to filing the new claim in January 2025. Turning to the evidence, a March 2024 VA psychiatric examination showed that the symptoms consisted of depressed mood, anxiety, chronic sleep impairment, impaired judgement, disturbances of motivation and mood, difficulty establishing and maintaining effective work and social relationship, difficulty adapting to stressful circumstances, and inability to establish and maintain effective relationships. These symptoms resulted in occupational and social impairment with deficiencies in most areas. At such time, the Veteran reported that he was employed with the postal service and experienced limitations related to his wrists. He denied any suicidal/homicidal ideations. The examiner remarked that the Veteran was married to his second spouse since 2021 and reported no major issues. He continued to have shared custody with his child from his first marriage but endured custody issues and limited access to his daughter. He had friends but did not socialize much. Additionally, he continued to consume alcohol almost daily. Upon behavioral observations, the examiner noted the Veteran exhibited euthymic mood and congruent affect as well as goal directed behavior and was dressed appropriately and oriented at times. VA clinical records show the Veteran continuously reported symptoms related to depression, anxiety, and trouble sleeping but denied suicidal ideations. Based on record, the overall disability picture does not support a 100 percent rating during this timeframe. The evidence does not show gross impairment in thought processes or communication, persistent delusions or hallucinations, grossly inappropriate behavior, persistent danger of hurting herself or others, disorientation to time or place, memory loss for names of close relatives, own occupation or his name, or any symptoms like or similar to those. While the Veteran reported some substance abuse, he was not determined to be a persistent danger to himself or others. Instead, the symptoms of depressed mood, anxiety, chronic sleep impairment, impaired judgement, disturbances of motivation and mood, difficulty establishing and maintaining effective work and social relationship, difficulty adapting to stressful circumstances, and inability to establish and maintain effective relationships, and others as described above are symptoms consistent with a 70 percent rating. Accordingly, the medical evidence does not support a rating in excess of 70 percent prior to November 13, 2024. Subsequently, the Veteran underwent another VA medical examination in April 2025, which established symptoms consistent with a 100 percent rating. Based on the April 2025 VA examination, the rating was increased to 100 percent; however, the evidence does not support a higher rating prior to that time. Also, the clinical records were reviewed but show symptoms similar to those referenced in the March 2024 examination report. Moreover, at no point prior to the April 2025 VA examination does the medical evidence indicate symptoms more nearly approximate a 100 percent rating. Therefore, the medical evidence does not support a 100 percent rating prior to November 13, 2024. The Board has considered the Veteran's statements and arguments that an earlier effective date for an increased rating for adjustment disorder with mixed disturbance of emotions and conduct with panic attacks, insomnia disorder, and alcohol use disorder is warranted. While he is competent to make lay observations and arguments regarding the effective date, they are unsupported by the law governing the assigning of effective dates. As such, an earlier effective date for a 100 percent rating for adjustment disorder with mixed disturbance of emotions and conduct with panic attacks, insomnia disorder, and alcohol use disorder is denied. Finally, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, for the Board's consideration. See Doucette v. Shulkin, 28 Vet. App. 366, 369-370 (2017) (confirming that the Board is not ? required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). L. HOWELL Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Y. Asfaw, Counsel The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.